Women don’t often experience crushing chest pain—the classic sign of a heart attack. Instead, their symptoms are often subtle. Women who experience one or more of the following symptoms should seek prompt medical care:

pain in the chest, shoulder blade or upper back

shortness of breath

dizziness

nausea and vomiting

anxiety with a feeling of impending doom

profuse sweating

abdominal pain

You know about hot flashes, insomnia and other bothersome symptoms that can accompany menopause. But did you know that heart disease comes with the territory, too? Before menopause, women have a lower incidence of heart attacks and other heart conditions than men do because of their high estrogen levels.

Estrogen helps prevent high blood pressure by keeping your blood vessels open. It also raises HDL, or good cholesterol, which helps prevent plaque from forming in your vessels. But as women age, they produce less estrogen and their risk of heart disease starts to rise.

More than half of all deaths in women over age 55 are caused by cardiovascular disease. While replacing lost estrogen through menopausal hormone therapy was standard practice for many years, government studies have since shown that hormones don’t offer the same heart protection they did at a younger age and may do more harm than good. The best way to keep your heart healthy as you age is to:

Modify your lifestyle

Quit smoking. It’s a major cause of heart disease in women. Secondhand smoke at home or at work increases the risk even if you’re a nonsmoker. No matter how long you’ve been smoking, your risk of heart disease drops rapidly when you quit.

Limit alcohol to one drink a day. Moderate drinking may reduce bad cholesterol and prevent blood clots. But drinking three or more drinks a day can cause high blood pressure, stroke and heart failure. So, if you don’t drink, don’t start.

Get active. Aim for 30 minutes of activity on most days of the week. Physical activity has proven benefits for your heart. And it reduces stress, anxiety and depression.

Eat a low-saturated-fat and high-fiber diet. Emphasize fruits, vegetables and whole grains. Eat more fish and less meat and limit dairy.

Brighten your attitude. The Normative Aging study suggests that people who are angry and hostile may be three times more likely to develop heart disease than those who are friendly.

Get routine checkups

Have your cholesterol checked yearly or more often as directed by your healthcare provider. High blood cholesterol is a major risk factor for heart disease. Total cholesterol of less than 200 mg/dL is desirable, 200–239 mg/dL is borderline-high risk and 240 mg/dL and over is considered high risk.

Have your blood pressure checked on all routine office visits. More than half of all women over 55 develop elevated blood pressure, which is another major risk factor for heart disease. Normal blood pressure is less than 120/80 mm Hg. High blood pressure is 140/90 mm Hg or above.

Get screened for depression. Untreated depression can raise your blood pressure by increasing stress hormones in the body. It also increases C-reactive protein, an inflammation marker that promotes heart disease.